- CVS Health (Springfield, IL)
- …all with heart, each and every day. **Position Summary** As the Manger of Business Compliance of Quality Review, Training, and Program Integrity, you will lead ... development of team members, managing quality review processes, and ensuring compliance with state regulations and contractual requirements. _Flexible on location… more
- CVS Health (Springfield, IL)
- …strategic initiatives, along with a team of medical coders/nurses supporting Aetna 's Special Investigations Unit. Key Responsibilities: + Leadership: Leads a team ... distribution and exposure to wide range of reviews. Assist with business opportunities aligned to inventory allocation and prioritization. + Quality Control… more
- CVS Health (Springfield, IL)
- …And we do it all with heart, each and every day. **Position Summary** The Aetna Pharmacy Health Plan Compliance team is seeking an experienced professional with ... pharmacy programs and benefit plans, to identify and track business and compliance risks and issues and...to become compliant. Our team collaborates with both the Aetna Health Plan business teams and with… more
- CVS Health (Springfield, IL)
- …Manage Third Party Risk Governance process for your assigned TPA(s). + Manage ongoing Aetna compliance review process for your assigned TPA(s). + Manage monthly ... manages competitive and complex contractual relationships with TPAs and/or business partners in Europe, APAC, Africa and Middle East...TPA networks are timely reviewed and uploaded on internal Aetna systems. + Ensure TPA guides, country guides and… more
- CVS Health (Eureka, IL)
- …do it all with heart, each and every day. **Position Summary** This Case Manager Registered Nurse position is with Aetna 's Long-Term Services and Supports (LTSS) ... - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies...every effort to respond to your request within 48 business hours and do everything we can to work… more
- CVS Health (Springfield, IL)
- …Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class ... goals * Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures… more